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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The intraoperative transcutaneous partial pressure of oxygen (PtcO2) was used to monitor 58 vascular reconstructive surgery procedures in 54 patients. The study comprised three groups: Group A (24 limbs without any ischemic symptoms or signs), Group B (45 limbs with intermittent claudication), and Group C (12 limbs with ischemic rest pain, ulceration, and gangrene). In addition in 31 patients the chest wall was monitored simultaneously as a control. The results showed that the PtcO2 values increased immediately and significantly to varying degrees and at varying speeds after unclamping. The controls had higher values than Group A (P > 0.05), Group B (P < 0.05), and Group C (P < 0.05) patients. Further study showed that there were no significant differences between the maximal values in the limbs with good distal vessel run-off in Groups A, B, and C, and in the controls (P > 0.05). It is thus concluded that effective vascular reconstruction in the limbs is indicated by a rapid and marked increase of both the PtcO2 value and the response value, while with a slow and low increase of the value, early graft failure and poor distal vessel run-off should be suspected. We believe that this monitoring method dynamically reflects the functional state during vascular reconstruction and is clinically valid.
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PMID:Evaluation of the measurement of the intraoperative transcutaneous partial pressure of oxygen (PtcO2) as a prognostic indicator in vascular reconstruction. 147 92

Hematocrit dependent changes of muscle tissue oxygen supply at rest and after exercise were detected in 23 patients with chronical arterial occlusive disease stage IIb according to Fontaine. In these patients with a concomitant high hematocrit a stepwise isovolemic hemodilution by vena esection and subsequent infusion of 10% hydroxyethylstarch solution (200/0.5%) was achieved intraindividually. Measurements of muscle tissue oxygen pressure (pO2) values in the lower limb muscle using a standardized pedalergometric exercise test as well as pain free walking distance with a treadmill were performed. Improvement of muscle tissue pO2 supply after pedalergometric exercise as well as muscular performance on the treadmill were found at an average hematocrit value of 40.50%, whereas muscle tissue oxygen supply and pedalergometric performance were markedly reduced at hematocrit 50.60% as well as 33.75%. Thus it is likely that an improvement of muscle tissue oxygen supply in severe intermittent claudication can be achieved by isovolemic hemodilution to hematocrit values about 40-41%.
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PMID:Hematocrit dependent changes of muscle tissue oxygen supply in the lower limb muscle of patients with intermittent claudication. 148 67

32 patients (mean age 65 years, range 51-75 years) were included in this controlled, double blind study to evaluate the effect of dipyridamole in patients with intermittent claudication. Following a run-in phase of one month, 15 patients received 400 mg dipyridamole per day and 17 patients placebo. Patient characteristics (risk factors, age, clinical and apparative tests) of both groups did not differ significantly before and during the study period. Mean pain free und absolute walking distance on the treadmill (3.2 km/h, 12.5 degrees gradient) increased significantly in both groups during study period (p < 0.001 and p < 0.01). Explanations are more intensive physical activity and increasing adaptation to treadmill exercise. However, dipyridamole did not induce a significantly longer walking distance in comparison with placebo. The working hypothesis that the drug with inhibiting properties of thrombocyte function prolongs walking distance in intermittent claudication, could not be confirmed.
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PMID:[Double-blind study of the effect of dipyridamole in patients with intermittent claudication]. 148 74

Twenty-two patients with intermittent claudication were prospectively enrolled in a 12-week program of supervised, graded treadmill exercise therapy. Severity and distribution of arterial occlusive disease were ascertained by noninvasive determination of segmental lower extremity blood pressures and waveforms. No attempt was made to modify risk factors for atherosclerotic occlusive disease. The exercise-induced reduction of the ankle pressure and its recovery were recorded over time, and the area under this curve, the "ischemic window," represents the severity of the ischemic deficit. Absolute systolic ankle pressure, ankle-brachial index, maximum walking time, claudication pain time, and the ischemic window were measured before and after exercise training in all subjects. Maximum walking time and claudication pain time increased 659% and 846%, respectively, among the 19 patients completing the 12-week program (p = 0.001; p = 0.0002). These patients underwent a mean reduction of 58.7% in the ischemic window after a standardized workload (p less than 0.05), and this correlated with the degree of symptomatic improvement. Absolute ankle pressure and ankle-brachial index were unchanged after exercise training. This study confirms the utility of supervised exercise therapy in the treatment of intermittent claudication. The ischemic window is a useful method for quantifying the ischemic deficit produced by exercise and provides a reproducible means of documenting functional improvement in patients undergoing exercise training.
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PMID:The ischemic window: a method for the objective quantitation of the training effect in exercise therapy for intermittent claudication. 149 49

Pain may be absent from the various manifestations making up a post-phlebitis syndrome but when it is present it varies considerably from one patient to another. Thus the very common feeling of heaviness, generally not painful, may be perceived as being painful by certain patients either because of the particular severity of the feeling or because of a low pain threshold in certain cases. Since no method for the objective measurement of pain exists, the assessment of this symptom and of its severity remains highly subjective, most often based upon statements by the patients. However, in practice a distinction can be drawn between the following: Pain related to venous stasis: a simple feeling of heaviness most often but which, in certain patients, may take on a painful connotation. Among such "stasis" pains, particular mention must be made of venous intermittent claudication, a progressive feeling of calf tension during walking which becomes increasingly painful and finally forces the sufferer to stop. This symptom is generally linked to the obstruction of a large collecting vein. Pain accompanying a leg ulcer usually results from secondary infection. Mention may be made of the role of inflammatory lesions developing around the trophic problem and which may encompass nerves, in particular the internal saphenous nerve. Although classical, causalgia type pain is certainly rarer. Demyelinisation of peripheral nerves has been suggested as being at its origin. Once again, the role of inflammatory processes linked to secondary infection appears to be notable. The treatment of pain in a post-phlebitis patient must take the greatest possible account of the pathophysiology of the post-phlebitis syndrome responsible: disinfection of a leg ulcer, treatment of venous stasis by elastic support, or by surgery or sclerosing injections. Sympathectomy has been suggested in causalgia type pain. In fact, this operation has scarcely any indications in post-phlebitis syndrome.
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PMID:[Painful manifestations of the sequelae of phlebitis]. 149 32

In 1973 LeVeen et al. described a new technique for extensive, retroperitoneal disobliteration of the aorto-bifemoral tract using the arterial disobliteration device (ADD). In Europe this technique was first described in 1981 by Widdershoven and Willekens. Later on more publications from Spain, Poland, Belgium and the Netherlands appeared. At the Groot Ziekengasthuis in 's-Hertogenbosch (the Netherlands) the new procedure was introduced in 1984. Until 1991, 158 patients were operated. The results were analysed. The average follow-up time was 44 months (range 3-84). In 44.5% of these patients intermittent claudication was the reason for operation. In 40.5% of the cases there was untreatable ischemic rest pain and in 15% there was also ischemic gangrene of one or both legs. Aorto-bi-iliac disobliteration was performed in 55 patients, aorto-bi-femoral disobliteration in 31 patients and unilateral disobliteration in another 48 patients. In 24 patients we performed an unilateral aorto-femoral with a contralateral aorto-iliac desobstruction. Both the operation technique and the results are described. Five patients died in the early postoperative period and in 16 patients early reintervention i.e. within 6 hours after the initial operation was necessary for hemorrhage or acute vascular occlusion. During the follow-up 15 patients died. Recurrent occlusion was seen six times while in two patients restenosis developed. In conclusion; in selected patients with aorto-femoral occlusive disease the ADD-procedure can replace the up to now usual procedures.
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PMID:["Endarterectomy revisited": long-term results of aorto-iliac disobliteration with the "arterial disobliteration device" (plaque cracker). A 7-year follow-up study]. 152 31

We reviewed the records of approximately 1,500 patients seen in the Vascular Laboratory of the Cincinnati Veterans Affairs Medical Center from 1980 to 1987 and identified 23 patients (25 limbs) who met all of the following criteria: 1) an ankle/brachial index less than or equal to 0.35; 2) an ankle or transmetatarsal pulse volume recording less than or equal to 3 mm in amplitude; and 3) no history of ischemic rest pain or gangrene. These patients were followed in the Vascular Laboratory for periods ranging from 11 to 127 months (mean 45.2 months). The study was terminated in March 1991 or when revascularization or amputation was required for limb-threatening symptoms or if the patient expired. Thirteen extremities (52%) showed no progression to limb-threatening symptoms. Claudication actually improved in three, remained unchanged in eight, and progressed in two. Twelve (48%) extremities developed limb-threatening conditions, with rest pain occurring in three, ischemic ulceration in six and gangrene in three. Eight of these limbs underwent revascularization and only one ultimately required major amputation. Another extremity presented with extensive gangrene and underwent a primary above-knee amputation. Three other patients did not undergo revascularization because of death in one and refusal in two others. Patients with intermittent claudication who have critical hemodynamic indices are at much greater risk for developing symptomatic limb-threatening ischemia. Close follow-up is mandatory since nearly half of these patients will eventually require operation for limb salvage. Patients who are unlikely to comply with a regular follow-up program may be considered for early revascularization to prevent complications of limb-threatening ischemia.
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PMID:Natural history of claudicants with critical hemodynamic indices. 154 73

A double-blind, randomized multicentre study was undertaken to evaluate the possible effect of chelation treatment with ethylenediamine-tetraacetic acid (EDTA) in patients with severe intermittent claudication. A total of 153 patients received 20 intravenous infusions of either 3 g Na2EDTA or placebo during a period of 5-9 weeks. Vitamin, mineral and trace element supplements were administered orally. The changes observed in the pain-free and maximal walking distances, measured on a treadmill, were similar in the two groups. During the 3-month (n = 149) and 6-month (n = 123) follow-up period, no long-term therapeutic effect of EDTA could be demonstrated. The ankle-brachial blood pressure index remained unchanged throughout the study period. This study failed to demonstrate any effect of EDTA chelation treatment in intermittent claudication.
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PMID:EDTA treatment of intermittent claudication--a double-blind, placebo-controlled study. 771 67

The results of 1051 extremities, operated for peripheral vascular disease are presented. The follow-up was at least 15 years, the longest 29 years. 778 extremities underwent surgery for intermittent claudication, 273 for rest pain or necrosis. The overall results are acceptable and encourage the indication for reconstruction even in intermittent claudication in patients over 50-years-old. The two groups of extremities were compared as to patency rate, reocclusion, amputation rate and mortality. It is of great interest that the great majority of patients dying in the follow-up have open reconstructions and have therefore taken advantage of surgery in being free of walking difficulties up to their death. Patients below 50 years with intermittent claudication should not be admitted to surgery, because the risk of amputation before death is great.
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PMID:[Differences in the prognosis of arterial reconstruction in stage II and IV peripheral arterial disease. Results of a minimum of 15 to 25 years follow-up]. 158 90

A previously healthy 48-year-old woman developed, over several months, increasing pain in her hips, cervical and lumbar spine as well as the shoulders. In addition she developed intermittent claudication after walking 100-200 m. Erythrocyte sedimentation rate (ESR) was 35-43 mm in the first hour; the IgM concentration was raised to 610 mg/dl. Angiography demonstrated symmetrical occlusion of both superficial femoral arteries. An attempt at thrombolysis having failed, a biopsy of the femoral artery wall was obtained. This revealed a florid arteritis, in part as giant-cell arteritis with destruction of the elastic structures, while the adjacent muscle was unchanged. Subsequent biopsy of the temporal artery was normal. Treatment consisted at first of 60 mg prednisolone and 100 mg aspirin, both daily for 4 weeks. The ESR fell and the free-of-pain walking distance rose. There has been no recurrence of pain after stepwise reduction over one year of the steroid dosage until its discontinuation.
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PMID:[Giant-cell arteritis limited to the femoral arteries]. 161 66


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